title: Enhanced tuberculosis identification through 1-month follow-up of smear-negative tuberculosis suspects.
abstract: METHODS
  Bandim Health Project, Bissau, Guinea-Bissau.
  
  
  OBJECTIVE
  To conduct tuberculosis (TB) screening among former TB suspects in whom TB had been ruled out on initial consultation and therefore assumed to be TB-negative (aTBneg).
  
  
  METHODS
  In a cohort follow-up study, 'aTBneg suspects' were screened for symptoms from 1 month after the initial negative sputum smear examination. Symptomatic individuals were referred for clinical re-examination and human immunodeficiency virus (HIV) testing.
  
  
  RESULTS
  Among 428 TB suspects presenting over a 10-month period in 2007, 80% (343) were smear-negative. Of these, 21 were subsequently diagnosed with smear-negative TB. Of the remaining 322 aTBneg patients, 212 were followed up and symptoms were examined ≥1 month after initial examination. Among followed up patients, 89 (42%) were still symptomatic: five were diagnosed with TB on the basis of repeated sputum smears and chest X-ray. Of 44 symptomatic patients, 39% (n = 17) were HIV-infected. Thirteen (4%) of the 322 aTBneg suspects died before follow-up.
  
  
  CONCLUSIONS
  A large proportion of aTBneg patients remained symptomatic after 1 month. Several TB cases had initially not been diagnosed, and HIV infection was highly prevalent. aTBneg suspects have a high mortality rate and need increased attention from both TB and HIV programmes.
authors.affiliation: Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.
authors.forename: A
authors.initials: A
authors.lastname: Porskrog
authors.forename: M
authors.initials: M
authors.lastname: Bjerregaard-Andersen
authors.forename: I
authors.initials: I
authors.lastname: Oliveira
authors.forename: L C
authors.initials: LC
authors.lastname: Joaquím
authors.forename: C
authors.initials: C
authors.lastname: Camara
authors.forename: P L
authors.initials: PL
authors.lastname: Andersen
authors.forename: P
authors.initials: P
authors.lastname: Rabna
authors.forename: P
authors.initials: P
authors.lastname: Aaby
authors.forename: C
authors.initials: C
authors.lastname: Wejse
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006169:Guinea-Bissau / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D013183:Sputum / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology